Purpose of Review
Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by microvascular dysfunction, immune activation, and progressive fibrosis affecting the skin and multiple internal organs. As survival improves, an increasing number of patients with SSc are exposed to surgical procedures. This review aims to examine key dermatologic manifestations of SSc and explore their relevance to perioperative and postoperative risk, highlighting the role of the skin as a clinically accessible marker of surgical vulnerability. 

Recent Findings 
Cutaneous involvement is the earliest and most consistent feature of SSc and reflects the severity of underlying vasculopathy and fibrosis. Manifestations such as skin thickening, Raynaud’s phenomenon, digital ulcers, telangiectasias, calcinosis, and orofacial fibrosis are closely associated with cardiopulmonary disease, impaired wound healing, difficult airway management, and increased risk of perioperative complications. Emerging evidence supports the prognostic value of these dermatologic features as indicators of perioperative cardiovascular, pulmonary, infectious, and thrombotic risk.

Summary Dermatologic 
manifestations in systemic sclerosis extend beyond diagnostic relevance and provide valuable insight into perioperative risk. Integrating focused skin assessment into perioperative evaluation may improve risk stratification, guide anesthetic and surgical planning, and enhance postoperative surveillance. A structured, phenotype-based approach that incorporates dermatologic findings into multidisciplinary perioperative management may contribute to improved surgical outcomes in patients with systemic sclerosis.